title: Mortality and recurrence risk in relation to the use of lipid-lowering drugs in a prospective breast cancer patient cohort.
abstract: Lipid-lowering drugs are used for the prevention of cardiovascular diseases. Statins are the most commonly used lipid-lowering drugs. Evidence from preclinical and observational studies suggests that statins might improve the prognosis of breast cancer patients. We analyzed data from the German MARIEplus study, a large prospective population-based cohort of patients aged 50 and older, who were diagnosed with breast cancer between 2001 and 2005. For overall mortality, breast-cancer specific mortality, and non-breast-cancer mortality, we included 3189 patients with invasive breast cancer stage I-IV, and for recurrence risk 3024 patients with breast cancer stage I-III. We used Cox proportional hazards models to assess the association with self-reported lipid-lowering drug use at recruitment. We stratified by study region, tumor grade, and estrogen/progesterone receptor status, and adjusted for age, tumor size, nodal status, metastases (stage I-IV only), menopausal hormone treatment, mode of detection, radiotherapy, and smoking. Mortality analyses were additionally adjusted for cardiovascular disease, diabetes mellitus and body-mass index. During a median follow-up of 5.3 years, 404 of 3189 stage I-IV patients died, and 286 deaths were attributed to breast cancer. Self-reported use of lipid-lowering drugs was non-significantly associated with increased non-breast cancer mortality (Hazard ratio (HR) 1.49, 95% confidence interval (CI) 0.88-2.52) and increased overall mortality (HR 1.21, 95% CI 0.87-1.69) whereas no association with breast cancer-specific mortality was found (HR 1.04, 0.67-1.60). Restricted to stage I-III breast cancer patients, 387 recurrences occurred during a median follow-up of 5.4 years. We found lipid-lowering drug use to be non-significantly associated with a reduced risk of recurrence (HR 0.83, 95% CI 0.54-1.24) and of breast cancer-specific mortality (HR 0.89, 95% CI 0.52-1.49). Although compatible with previous findings of an improved prognosis associated with statin use, our results do not provide clear supportive evidence for an association with lipid-lowering drug use due to imprecise estimates.
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Nickels
authors.forename: Alina
authors.initials: A
authors.lastname: Vrieling
authors.forename: Petra
authors.initials: P
authors.lastname: Seibold
authors.forename: Judith
authors.initials: J
authors.lastname: Heinz
authors.forename: Nadia
authors.initials: N
authors.lastname: Obi
authors.forename: Dieter
authors.initials: D
authors.lastname: Flesch-Janys
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology*; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011987:Receptors, Steroid / Q000378:metabolism; D018570:Risk Assessment
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011987:Receptors, Steroid